Kerry Middleton Case Summary

The diagnosis of PTSD requires one or more symptoms from three main categories. The first category is re-experiencing the event. This can include reliving the event through nightmares, upsetting thoughts, flashbacks, or anything that can remind the person of the traumatic event, making them have physical and mental reactions ("Post-traumatic Stress," 2014). Next, the second category is avoidance. The individual will avoid thoughts, activities, or conversations that can remind them of the traumatic event. The third stage to diagnose PTSD is increased arousal in your life including, a loss of interest in important things you need such as decreased sleep and being unable to concentrate in your day to day life ("Post-traumatic Stress," 2014). Major depression, substance abuse, and panic can also correlate with PTSD. This diagnosis requires these symptoms to be bad enough to interfere with your daily life and last at least a month.

Post-traumatic stress disorder (PTSD) is a relatively new diagnosis that was associated with survivors of war when it was first introduced. Its diagnosis was met largely with skepticism and dismissal by the public of the validity of the illness. PTSD was only widely accepted when it was included as a diagnosis in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) of the American Psychiatric Association. PTSD is a complex mental disorder that develops in response to exposure to a severe traumatic event that stems a cluster of symptoms. Being afflicted with the disorder is debilitating, disrupting an individual’s ability to function and perform the most basic tasks.

At least 50% of all adults and children are exposed to a psychologically traumatic event (such as a life-threatening assault or accident, humanmade or natural disaster, or war). As many as 67% of trauma survivors experience lasting psychosocial impairment, including post-traumatic stress disorder (PTSD); panic, phobic, or generalized anxiety disorders; depression; or substance abuse.(Van der Kolk, et al, 1994) Symptoms of PTSD include persistent involuntary re-experiencing of traumatic distress, emotional numbing and detachment from other people, and hyperarousal (irritability, insomnia, fearfulness, nervous agitation). PTSD is linked to structural neurochemical changes in the central nervous system which may have a direct

PTSD having been on the rise following various deployments necessitated by the various wars against terror, where the soldiers encounter traumatic experiences like harsh training conditions, unfavorable living standards, enemy attacks, extreme working environment, explosions, torture by enemies, loss of colleagues as well as long term separation from family back at home (Melinda S & Jeanne S., 2012). This therefore calls for a concerted effort in handling the pandemic of PTSD since it has been constantly on the increase and as a

“Post-Traumatic Stress Disorder” 2014 states symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. For symptoms to be considered under the category of PTSD, they must last for over a month and must be reoccurring. Every person is different. Sometimes people can be cured of PTSD within six months and it would have been acute or even temporary PTSD, but others could take years to be cured which at that point it would be considered as chronic or long-term PTSD. A doctor who has experience helping people with mental illness, such as a psychiatrist, or a psychologist, can diagnose PTSD. As mentioned before, to be diagnosed with PTSD it must be a reoccurring symptom, but anyone can just claim a reoccurring symptom and call it PTSD. “Post-Traumatic Stress Disorder” 2016 stated that the specifics are at least one re-experiencing symptom, at least one avoidance symptom, at least two arousal and reactivity symptoms and at least two cognition and mood symptoms.

PTSD is a psychological problem that affects people who have survived a traumatic experience. When a person experiences a traumatic event in their life, that event leaves a type of scar on their mind. Unlike physical scars, psychological scars may not heal and the person may be unaware of their symptoms. While these “scars” may not be obvious at first, they may cause problems later in life, sometimes months or years later. This makes recognizing the disorder difficult. However, much research in recent years has increased people’s knowledge of the symptoms of PTSD. It was first defined as a disorder in 1980 by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) (Galea et al., 2005).

Roughly two million troops have been deployed to the conflicts in Iraq and Afghanistan since September 2001. Current conflicts in Iraq and Afghanistan have resulted in a number of investigations examining the post deployment mental health among military personnel serving in these regions. The primary focus of research on returning veteran has been on Post Traumatic Stress Disorder(PTSD), specifically on the etiology, preventative measures, and treatment of PTSD. Some of the risk factors for military members to develop PTSD include: combat experience, being wounded, witnessing death, serving on graves registration duty or handling human remains, being captured or tortured, being exposed to unpredictable and uncontrollable stress, and experiencing sexual harassment or assault (Institute of Medicine,

“Post-traumatic stress disorder (PTSD) is a debilitating mental disorder that follows experiencing or witnessing an extremely traumatic, tragic, or terrifying event. People with PTSD usually have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to.” (psychcentral.com).Three point six percent (five point four million) of U.S. adults develop Post-Traumatic stress disorder in a given year (National Center for PTSD). Post- traumatic stress disorder is classified as acute, chronic or delayed onset. Acute post-traumatic stress disorder presents with symptoms that do not persist beyond three months, while in the chronic form the symptoms last more than three months. Delayed onset post-traumatic stress disorder is the one in which the symptoms start appearing about six months following exposure to the traumatic event. As compared to normal stress that is usually associated with acute reactions that rapidly return to the normal state, the biological and psychological mechanisms in post-traumatic stress disorder are chronic

The National Institute of Mental Health (2016) defines PTSD as “a disorder that develops in some people who have experienced a shocking, scary, or dangerous event”. Both the United States department of Veterans Affairs, and the National Institute of Mental health have similar definitions regarding what PTSD is and how to treat it. In most cases PTSD symptoms begin showing within three months of when the initial incident occurred. However, in some cases, they can begin years after the traumatizing event, often being triggered by an outside entity. For an individual to be diagnosed with PTSD they must meet a specific set of criteria. To be diagnosed with PTSD a person must suffer from symptoms such as re-experiencing the event, avoidance, arousal and reactivity (trigger re-experience event), and cognition and mood symptoms (National Institute of Mental Health, 2016). All of these symptoms must be present in a client for at least one month before being diagnosed with PTSD.

Diagnostic criteria for PTSD includes a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of the four symptom clusters included in the DSM-5: intrusion, avoidance, negative alterations in cognition and mood, and alterations in arousal and activity. The sixth criterion concerns duration of symptoms; the seventh assesses functioning; and, the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition.

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after experiencing a dangerous and/or terrifying event (Psychology Today, 2015). PTSD is associated with changes in brain function and structure and these changes provide clues to the causes, treatment, and prevention of PTSD (PTSD United, 2013). This condition can appear at any age and currently affects about 7.7 million American adults (Psychology Today, 2015). Before 1980, the legitimacy of PTSD was debated by the general public as well as health professionals (PTSD United, 2013). At one point in time, it was considered a psychological condition of combat veterans who were dismayed by and unable to deal with their experiences on the battlefield (PTSD United, 2013).

According to a study done by the Nebraska Department of Veteran Affairs, “An estimated 7.8 percent of Americans will experience PTSD at some point in their lives, with women (10.4%) twice as likely as men (5%) to develop PTSD”. The common reasons for men to get PTSD is rape, combat exposure, childhood neglect, and childhood physical abuse. Women are more susceptible to PTSD because of rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse. In 2013, the Boston marathon was bombed and 3 people died and over 200 were injured. Only a minority of people who were exposed to this attack as well as the subsequent manhunt and city wide shut down, will develop PTSD because the brain has other ways to heal itself. Some might develop relatively temporary anxiety and/or depression for example, they may have “survivor’s guilt”. Where the person who goes through a life-threatening experience and lives becomes depressed because he/she believes that they should not have been the one to live or they feel like it might be their fault that they were the ones to cause the incident in the first place. But for most, they will have the usual emotional response but will not have any illness at all. The most common place most people hear about PTSD might be from the news when they talk about the soldiers who come back from war. A study by the RAND Center for Military Policy Research shows that, out of 2.7 million Afghanistan and Iraq war veterans, more than 20% of veterans will be diagnosed with PTSD or have signs of PTSD. Out of those 20%, studies show that 5% to 50% of veterans will not seek out treatment and those who do only report “minimally adequate” treatment

Post Traumatic Stress Disorder is something that has plagued the military for years. Coined as "Shell Shock" during World War I, symptoms included "fatigue, tremor, confusion, nightmares and impaired sight and hearing" (Dr. Edward Jones 2012, 2). Very similar to the modern PTSD victim, these symptoms can quickly turn life altering. Many things can strike a PTSD flashback, an unexpected loud noise, and a familiar smell, pent up stress, even something such as driving down the road. According to the Department of Veterans Affairs, over 1.8 million men and women have deployed in support of the War on Terror, and since it’s begging, over 300,000 service members have been treated for Post Traumatic Stress. This totals approximately 18% of all returning veterans. As shocking as this number is, this only reflects the amount of veterans that have sought treatment. Many more turn to other sources to deal with their problems.

PTSD is the abbreviation for Post Traumatic Stress Disorder. The general classification according to the DSM-V is 309.81 with an Axis I. This disorder is no longer classified as an anxiety disorder rather it is now classified as a trauma and stressor related disorder. That means anyone who experienced (direct exposure), witnessed or was confronted with an event that they might have feared for their life, and or caused serious injury to them, such as a sexual trauma event like rape. This can happen to anyone at any age, it is not just a soldier’s disorder and it haunts them for a very long time. In order to be diagnosed with PTSD there is a criterion that they use to evaluate or meet the individual’s needs for treatment. The

Individuals with PTSD persistently re-experience their traumatic event in their thoughts, perceptions, imagery, dreams, illusions, hallucinations, and flashbacks. They may experience intense physiological distress or reactivity to cues of the traumatic event. These individuals persistently avoid any stimuli associated with the traumatic event and use other mechanisms to cope with any situation or cue that recalls or contradicts their emotional or cognitive responses to the traumatic event (American Psychiatric Association [DSM-IV-TR], 2000). Individuals with PTSD also experience persistent symptoms of increased arousal, such as irritability and difficulty concentrating. These disturbances can cause significant distress in social life, the work place, and family systems. According to the American Psychiatric Association (DSM-IV-TR), in order for individuals to be diagnosed with PTSD they must experience disturbances and symptoms for more than one month (2000). Symptoms can be specified as acute (less than 3 months), chronic (3 months or more), or with delayed onset; in which onset starts 6 months after the actual stressor (DSM-IV-TR, 2000).